Patients with ACS and cardiogenic shock who had access to health care centers that performed cardiac catherization were more likely to survive compared with those without access, according to a study published in the Canadian Journal of Cardiology.
John Colin Boyd, MSc, of Dalhousie Medical School at Dalhousie University in Halifax, Nova Scotia, Canada, and colleagues analyzed data from 14,205 patients who presented with ACS from 2009 to 2013. Data were collected from a clinical registry, which included detailed clinical information. Patients were diagnosed with ACS and cardiogenic shock either at admission or discharge.
ACS included any STEMI or non-STEMI. Access to invasive cardiac care was identified as patients who were either admitted or transferred to the only institution in Nova Scotia — the Queen Elizabeth II Health Sciences Centre in Halifax — that provided invasive cardiac surgery and cardiac catherization.
The primary outcome was in-hospital all-cause mortality. Other outcomes of interest included factors such as access to cardiac care at the specified health care center and timeliness of cardiac catherization.
From 2009 to 2013, 418 patients (mean age, 72 years) with ACS and cardiogenic shock were admitted to the hospital. Of these patients, 73.9% had access to cardiac catherization. In patients who presented with ACS and cardiogenic shock in other areas of the province, 64.2% were transferred to the health care center in Halifax.
Fewer patients with access to invasive care died compared with those without access (41.7% vs. 83.5%; P < .0001).
The mortality rates for patients who underwent PCI was 33.1%. After adjusting for clinical differences, access to cardiac catherization was an independent predictor of survival (OR = 0.2; 95% CI, 0.11-0.36).
Heat map analysis showed that access to invasive care was lowest in areas farthest from Halifax.
“Operational changes at a system level are complex, but modifications such as enhanced emergency medical services (EMS) systems and provincial monitoring programs may improve access to care,” Boyd and colleagues wrote. “Nova Scotia is fortunate to have a single EMS provider; therefore, limited adjustment to infrastructure and practice may be required, but its effect on patient outcome may not always be predicted to be positive.” – by Darlene Dobkowski
The authors report no relevant financial disclosures.